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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
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HFMA announced the release of a draft of new best practices that will bring more consistency, clarity, and transparency to patient financial interactions. The guidelines were released during ANI: The Healthcare Finance Conference, held June 16-19 in Orlando, Fla. The proposed guidelines are open for public comment until July 31.
Revenue Cycle Strategist subscribers are encouraged to comment on the draft guidelines at pfibestpractices.com.
The draft of Patient Financial Interaction (PFI) best practices can be viewed online at pfibestpractices.com, where comments on the proposed best practices may be submitted. Patient feedback also will be solicited in the coming months. The resulting final practices will be released in the fall for voluntary adoption by healthcare organizations across the country.
The proposed best practices were created by a steering committee that met monthly over the past year and included leaders from HFMA, the National Patient Advocate Foundation, the American Hospital Association, Harvard Medical School, and America’s Health Insurance Plans, among others.
The PFI project was overseen by an advisory panel consisting of Sen. Tom Daschle, Sen. Bill Frist, former Secretary of Health and Human Services Donna Shalala, Gov. Michael Leavitt, and attorney Jamie Gorelick. Leavitt Partners facilitated the Steering Committee process.
“Healthcare financial interactions can be complex and confusing because of complicated payment structures, dozens of different payers and forms, and varied government programs,” said Joseph J. Fifer, FHFMA, CPA, president and CEO of HFMA. “When you add the reality that patients are becoming responsible for greater proportions of their healthcare costs, clear guidelines and communication are more important than ever. These best practices are a critical component of HFMA’s ongoing effort to establish more consistent financial practices that are fair to all stakeholders while helping patients access and pay for the health care they need.”
The proposed best practices focus on financial interactions when medical services are scheduled as well as when emergency and non-emergency care is delivered. These practices provide guidance regarding when and how communication should take place about patient insurance coverage, financial counseling, patient financial responsibility for service, and any existing balance the patient may have. The best practices emphasize open and early communication, the sharing of clear information, and the identification of a path for financial resolution that is fair for patients and healthcare organizations alike.
“Patients and their families enter the healthcare system when they are most vulnerable, and then they encounter financial processes that are challenging even to veteran healthcare professionals,” said Nancy Davenport-Ennis, president and CEO of the National Patient Advocate Foundation and a member of the group that developed the best practices. “The early, clear financial conversations described in these best practices will help give patients peace of mind and help providers receive appropriate payment—both key objectives for the healthcare system to function with fairness and compassion.”
“Clear financial communication between patients and healthcare organizations is the right thing to do for all concerned, but our complex healthcare system makes clarity a challenge,” says Bert R. Zimmerli, executive vice president and CFO at Intermountain Healthcare and a member of the steering committee. “These best practices provide a guidepost that our industry will use to continuously improve these crucial financial interactions.”
HFMA will now move the project through implementation with the support of steering committee members. The project is one of a group of HFMA initiatives designed to promote fair and responsible financial practices in health care.
Publication Date: Wednesday, July 03, 2013
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Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
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Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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